My Patients and Other Animals

by Suzy Fincham-Gray

  Even more alienating than my desire to study hard was my lack of horsemanship. At ten I’d gone through a horse-obsessed phase and had persuaded my parents that riding lessons were a necessary part of my childhood. In jeans and wellies, my sister and I spent every other Saturday morning at the cheaper of the two stables in town, which was more tolerant of our lack of jodhpurs and fancy riding boots.

  However, it turned out that I was highly allergic to the beast I’d hoped to feed sugar lumps, and close contact with a horse resulted in instant sneezing and eye swelling. Still, this didn’t deter me. I continued taking riding lessons until I could no longer hide my blinding eye irritation from my parents.

  Notwithstanding my persistence, I never found equilibrium in the saddle. When my steed went from a trot to a canter, my grip tightened on the reins and my biceps flexed. My white-knuckled hands would rise until they were uselessly hovering in midair, while my feet curled desperately around the stirrups and my frustrated instructor screeched “Keep your hands down!” If I’m honest, I always preferred my Sindy (the UK’s more realistic version of Barbie) horse to the real thing. I could plait and style its mane and tail for hours, brushing the man-made fibers until they shone. There was no risk of being stood on or bucked off, and I didn’t need to care about my lack of jodhpurs, because Sindy had the perfect outfit, complete with velvet hard hat and riding crop. But at vet school I couldn’t avoid horses or the “horsey set” that I’d once so desperately wanted to belong to.

  * * *

  —

  My anatomy dissection class shared one horse—a pony, really—and one cow for the duration of the two-year preclinical course. The first day, they both hung from sturdy hooks through their backs, in disconcerting standing positions. Despite their posture, the nose-numbing tang of formaldehyde and the rubbery grayness of their muscles confirmed their lifelessness. The dissection room was in the basement of the veterinary school, and the only windows were high along one wall, lending a permanent fluorescent-lit austerity to our classes. It was cold and damp, and our white coats did little to protect us. If we didn’t roll our sleeves high enough, they slurped up the juices from the stainless steel dissection tables, the cuffs quickly turning a dingy pinkish gray.

  In addition to the two large animals at the front of the class, the headless body of a dog or goat lay on each of the tables positioned at precise intervals across the floor. A bucket hung beneath each one under the drain to catch escaping fluids. Trim, muscular ex-racing greyhounds lay stiffly on the cold metal surface, their legs extended and unbending.

  There weren’t enough dogs to go around. Local shelters wouldn’t donate the bodies of euthanized stray dogs for what was considered experimentation, so goats were substituted. Their anatomy was significantly different, but they were of a similar size. We spent painstaking hours in assigned groups of four, dissecting the nerves and blood vessels that were conveniently filled with blue latex for veins and red for arteries. One tiny part of anatomy was assigned each week; for example, the lower, lower half of the foreleg. Clustered around our dripping specimens, intently comparing the precise illustration in Miller’s Dissection of the Dog to the soggy mess of stringy tissues in front of us, I felt a camaraderie that I hadn’t discovered in the university bar. Dissecting the origin and insertion of a leg muscle and teasing apart its innervation was a more comfortable social engagement for me than enjoying a pint in the pub on the way home. Over two years, we gradually whittled down the bodies, with each diminishing carcass carefully restored to its preservative bath at the end of lab every week.

  The hours we spent in the cavernous anatomy hall seemed far removed from the consulting room in Hereford and George’s warm, cheerful voice. And the cold, set specimens were so separate from the living animals they’d once been that it never crossed my mind to be upset.

  That was until one Tuesday afternoon, toward the end of our first year, when we were assigned fresh horse’s feet from the local knacker’s yard. They had been severed above the fetlock, and the rim of skin and hair still attached to the foot made me wonder what the horse had looked like—an uncomfortable reminder that a short while earlier our specimen had been part of a living body. The flesh was petal pink and the cartilage glistening white, a stark contrast to the colors and textures we usually encountered in anatomy lab.

  Despite my unfamiliar proximity to living flesh, foot dissection wasn’t bad. The inside of the hoof is secretly beautiful, with tiny pleats that resemble the underside of a mushroom cap perfectly interlinking with matching folds on the pedal bone, almost enough to make you forget the desperate prying needed to separate the two halves.

  The knowledge we accumulated of the bones and joints, muscles, tendons, ligaments, and nerves of dogs and cats, goats, sheep, pigs, cows, and horses was tested in a qualifying anatomy examination at the end of our first academic year.

  On entering the anatomy lab, we were handed a thin booklet of papers. An overwhelming array of specimens lay before us to be identified, and I barely noticed the now-familiar sour smell. Our anatomy professor stood at the front of the hollow room with a timer linked to a buzzer. He was a tall, slim man with a vertical face, who looked at us through his glasses as if we were samples on a microscope slide.

  “Please choose a station and stand next to it,” he instructed.

  Each table displayed a different-sized morsel of preserved flesh, a foot on one, a forelimb on another. Some had ropey nerves exposed with pieces of string tied around them; others were studded with colored pushpins inserted into a muscle, tendon, or ligament. Each was tagged with a small piece of soggy paper with a number written in black marker.

  “Once you have selected a station, please find the corresponding page in your booklet,” the professor said. “You will see a question on the table next to the specimen. Please write the answer next to the appropriate number.” I glanced down nervously.

  “You will have ninety seconds at each station, and the buzzer will sound when it’s time to move on to the next.” The professor gazed disinterestedly around the room, already looking bored by the prospect of moderating an exam for the next two hours.

  “Any questions?” We stayed quiet.

  The damp fabric of my shirt caught on my back; the basement room was uncomfortably chilly. I quickly checked my lab coat pocket for the pen I knew was there and moved to the table on my right, where the hind limb of a goat rested. The muscles had been removed, and a piece of grayish string encircled a delicate, white-plastic-looking nerve. The shallow pool of clear liquid surrounding the limb moved determinedly to the edge of the table and the sleeves of my freshly washed lab coat.

  The buzzer sounded.

  * * *

  —

  At times during those first two years of veterinary school, when the only living animals I encountered were the fearless, sooty mice who lived between the tracks at the Tube stations, the relevance of the cellular pathways, molecular structures, and biologic mechanisms we studied seemed impossible to realize. And I began to think that I preferred it that way. My lack of horsemanship didn’t matter when the only horse I had to handle was fixed in formalin or on the pages of a textbook. The pain, suffering, and distress that disease caused animals were a long way from the frigid dampness of the dissection hall.

  But, eventually, after years in the anatomy lab and countless qualifying examinations, it was time to move to the clinical campus in Hertfordshire, a thirty-minute train ride from London. Despite my apprehension about dealing with live patients, it was thrilling to be within sight of the goal I’d set so long ago. My clinical studies lay ahead before I would graduate with a veterinary degree, and I was determined to apply myself with the same commitment I’d given my books. Our stained lab coats were replaced with new, freshly starched ones. The lectures we attended advanced from slides of cells to pictures of the animals they composed. And, finally, we were introduced to the living
embodiment of the anatomy, biochemistry, physiology, and pathophysiology we’d spent years studying.

  I took to the small animals and their owners, but equine medicine and surgery was still my most dreaded clinical rotation. The patients, and the people who owned them, stirred a deep and uncomfortable confusion within me. My green country wellies, practical in the hospital setting, nevertheless set me apart from the horsey set and their sleek boots with the discreet “Hunter” logo. The university’s equine staff were similarly dressed, and significantly more terrifying. There was one particular equine medicine professional who appeared to enjoy making students, interns, residents, and likely other faculty members cry, usually from fear and humiliation. She was the only woman on faculty in the equine department—a hangover from the male dominance of veterinary medicine. Her voice had a gravelly, piercing quality, her confident stride could be heard from twenty paces, and her reputation was fierce.

  My clinical duties on the equine rotation required me to jump out of bed at all hours, at the summons of my insistently bleeping pager, and rush to the hospital to “assist” with surgeries or administer medications. Medicating horses can be challenging, especially when you’re only half awake. Even instilling eyedrops was nearly impossible—the drops needed to be administered frequently, and a horse’s eye is in uncomfortable proximity to its surprisingly sharp teeth. Often we were forced to surgically implant elaborate catheters that tunneled underneath the reluctant horses’ strong eyelids to ensure proper application of ocular medications.

  The prospect of assisting with a surgery was barely more appealing. Surgery on horses can be difficult, and the risk of the procedure was terrifying. Before the patient arrived on the operating table there was anesthesia to administer. The sight of a sixteen-hand-tall horse crumpling to the ground was amazing, and we nervously hoped that no legs—human or equine—would be broken in the process. We used large padded boxes with mechanized lifting gear to anesthetize and then recover the huge animals. The anesthetists used endotracheal tubes thicker than my forearm to deliver oxygen and anesthetic gases to their enormous patients. Once the horses were asleep we would shackle and attach them to the overhead winch that lifted them into the operating theater. It could take a frenetic hour to get a horse anesthetized and delivered safely to the surgical table.

  Horses are not designed to lie in one place for long periods. Blood supply and oxygen delivery to vital areas becomes quickly compromised in recumbent horses due to their large muscle mass and dense skeletons. Additionally, the weight of their organs can cause lung collapse after an hour or two under anesthesia. Every surgery was a race against the clock, since we knew that the longer it took, the more likely it was that the horse wouldn’t get up. My role during surgery was narrowly defined. Occasionally I would be asked to hand over an instrument or hold suction equipment, but generally these minor tasks were considered by some too expert. Consequently, standing still—not touching or breathing on the sterile field—was the typical extent of my duties.

  However, I assumed it was unlikely that I would ever touch a horse in a medical capacity beyond my veterinary education. My passion did not lie in the surgical excavation of my patient’s tissues, and the diagnosis and treatment of disease in cats and dogs was further advanced than in large-animal medicine. This, combined with my ambivalence toward my larger patients, made it clear that my post-graduation interactions with hooved beasts would be limited. I knew that my future lay in small-animal medicine. I squirreled the information about equine, bovine, ovine, and porcine medicine away, tucking it into the sulci of my hippocampus, where it slowly faded, along with many of my memories of my years at veterinary school. There were some moments, though, that stayed with me long after my need for them had expired.

  * * *

  —

  “You remember what you’re going to do?” Peter asked.

  “Yes,” I answered, hoping he’d repeat the directions one last time.

  “You are going to draw an imaginary line from one ear to the opposite eye, and then repeat for the other ear and eye. The two lines will make an X. The spot where the lines cross is where you will place the gun. It’s going to be higher up than you think; remember that.”

  I nodded.

  “Tell me what you’re going to do next,” he said.

  “I’m going to position the gun’s muzzle flat against the horse’s head, at the same angle as the neck to the ground so the bullet goes directly into the cerebrum and cerebellum rather than across the top of the forehead.”

  “All right, good. Now once you’ve got the positioning right, remember that you want to squeeze the trigger gently; don’t jab at it with your finger, and whatever you do don’t step backward at the last moment. And don’t close your eyes. You’re only going to get one shot. It needs to be done right. We don’t want this horse to suffer.”

  My anxiety ratcheted up. I was being entrusted with a huge responsibility, and whatever I did, I didn’t want to mess it up. I pictured myself firmly gripping the lead rope attached to the head collar. I silently recited a mantra: I will not close my eyes. I will not close my eyes. I will not close my eyes.

  Peter loaded the gun, keeping the safety on, and we walked across the field. It wasn’t difficult to catch the pony. She was used to people, and we must have seemed like friendly visitors. We led her to the flattest part of the field, not far from the road. A scrubby hedge only partially blocked the view of passing traffic. My hands were shaking. I took the gun. I wanted to give it back, but I knew I would not. Peter stood several feet behind me.

  I reached up and gently patted the pony on her forehead. Up close I could see the sharp bones of her pelvis pushing against her skin. Brushing aside her wiry forelock, I silently calculated where to place my shot. Her gray hair softly bristled under my sweaty palm. I could smell her sweet, grassy horsiness.

  I gripped the gun in my left hand and raised it to the spot on her forehead. It felt heavier and denser than I’d imagined. I’d seen guns only in movies, being waved around with relaxed nonchalance. With my right hand I grasped the lead rope. Placing the pistol to her head helped steady my hand. Her gaze was level with mine, and for a moment I stared into the black-brown liquid of her eyes.

  I had one shot to get it right.

  The sound ricocheted and reverberated off the trees that lined the road. Obliterating and unmistakably metallic, it bounced and spun inside my head. I could hear nothing else. Where, a second ago, there had been a smallish gray pony, now there was just a field. I looked down, and there she was, her eyes open but flat. There was a perfectly round, dark hole in the middle of the imaginary cross on her forehead with red-black blood oozing out. I took my stethoscope out of my pocket and attempted to find her heart. My ears still deadened, I wondered if I would hear the slow thirty beats a minute even if a pulse was there. The noise and weight of my perfect shot lingered long after her last breath.

  I handed the gun to Peter, my hands still shaking, and we walked back to the car to drive to our next call. The knacker’s van would pull in shortly to pick up the body.

  “Well done,” Peter said.

  “Thanks.”

  “Did you keep your eyes open?” he asked.

  “Yes,” I lied.

  CHAPTER TWO

  Hercules

  In the middle of June 2000, I arrived in the United States with two suitcases, the promise of a rotating internship in small-animal medicine and surgery, and a J-1 visa. It was a month before I would technically graduate from veterinary school, and four days before I would discover if I’d passed my final exams and qualify as a veterinarian. Had I failed, my suitcases, visa, and I would’ve been on the next plane home.

  My first taste of American veterinary medicine had come during my penultimate year of college, when I spent a six-week externship at Cornell University, where the array of diagnostic tests available—and the lunch options
at the snack cart—seemed limitless. The small-animal hospital at the Royal Veterinary College is considered among the best in the United Kingdom, but it seemed modest and quaint compared to the caseload and facilities at Cornell. George, Peter, and the clinic I’d grown up in seemed like they were from a different century. I had a sense before my trip to Cornell that I wanted to pursue academic medicine after graduation. The idea of stepping into a practice straight out of school was unappealing, and I hadn’t outgrown my passion for studying. The two weeks I’d spent on the internal medicine rotation at Cornell had opened my eyes to the possibility of a career in small-animal internal medicine.

  Once I set my sights on my post-graduation goal I did everything in my power to achieve it, in the same way that I’d steadfastly pursued getting into and then through veterinary school. But when I realized that the opportunities to pursue specialized training in the United Kingdom were limited, I didn’t hesitate to apply for an internship in the States. Moving across the ocean to gain more advanced training didn’t feel like a decision; it was merely the next step on the path to achieving my goal. My time at university had already distanced me from my family, especially during the clinical years, when weekends were spent on call, and vacations were spent seeing practice. The small group of friends I’d established at vet school, and the boyfriend I’d started dating a few months before my departure, were no rival for my singular determination. It wasn’t until I stepped onto the plane at Heathrow that I could see everything and everyone I was leaving behind.

  The only things waiting for me in Philadelphia were the promise of an internship at the University of Pennsylvania and a room in an apartment I would share with two fellow interns. The apartment was on the second floor of a battered two-story house a five-minute walk from the University of Pennsylvania’s veterinary teaching hospital (VHUP) in West Philadelphia. And along with Dave and Chris—the intern mates I had yet to meet—I would also be sharing the apartment with their pets; a Doberman pinscher, a German shepherd, and several cats. It would be the first time I’d lived with the animals I’d studied.